Existing law, the California Global Warming Solutions Act of 2006, designates the State Air Resources Board as the state agency charged with monitoring and regulating sources of emissions of greenhouse gases. The act authorizes the state board to include the use of market-based compliance mechanisms. Existing law requires all moneys, except for fines and penalties, collected by the state board as part of a market-based compliance mechanism to be deposited in the Greenhouse Gas Reduction Fund and to be available for appropriation.

Existing law requires the California Department of Aging to designate various private nonprofit or public agencies as area agencies on aging to work for the interests of older Californians within a planning and service area and provide a broad array of social and nutritional services. Existing law states that the mission of the department is to provide leadership to the area agencies on aging in developing systems of home- and community-based services that maintain individuals in their own homes or the least restrictive homelike environments. Existing law establishes certain wellness, injury prevention, and other programs within the department to serve both older individuals and persons with a disability, as defined.

This bill would make grant awards available under the State Air Resources Boards Clean Mobility Options program for disadvantaged communities and low-income communities to eligible applicants, including, but not limited to, area agencies on aging and public transit operators. The grant awards would be used to fund transportation to and from nonemergency medical services for older individuals and persons with disabilities, for the purpose of reducing greenhouse gas emissions. The bill would require that transportation be made available using the purchase, lease, operation, or maintenance of zero-emission vehicles, or, under specified circumstances, near-zero-emission vehicles, with a capacity for 7 to 15 passengers, inclusive.

The bill would authorize the allocation of moneys from the Greenhouse Gas Reduction Fund, upon appropriation by the Legislature, to fund the grant program.

This bill would require the California Department of Aging, on or before July 1, 2020, to hold a public workshop devoted to the topic of overcoming barriers in providing transportation to and from nonemergency medical services for older individuals and persons with disabilities. The bill would specify the components of the workshop, including, but not limited to, presentations by the State Air Resources Board and public transit agencies on specified issues. The bill would repeal the public workshop provisions on January 1, 2021.

GOVERNOR'S VETO

GV Bill Id:AB 970

Author:(Salas)

As Enrolled Ver:September 6, 2019

2/3 vote

SUMMARY:

Makes grant awards available under the State Air Resources Board's Clean Mobility Options program for disadvantaged communities and low-income communities to eligible applicants. The grant awards would be used to fund transportation to and from nonemergency medical services for older individuals and persons with a disability, for the purpose of reducing greenhouse gas emissions.

The Senate Amendments:

1. Require the California Department of Aging to hold a public workshop devoted to the topic of overcoming barriers to providing transportation to and from nonemergency medical services for older individuals and persons with a disability on or before July 1, 2020.
2. Require the workshop to include, at a minimum, an identification of existing funding sources for these transportation purposes, including, but not limited to a presentation from the State Air Resources Board on existing state clean transportation incentive programs that could fund these transportation purposes; a presentation from public transit agencies on existing funding options available; a discussion of strategies and options that could be employed to better utilize existing funding sources; and would repeal effective January 1, 2021.
3. Permit the results of the workshop to be considered for inclusion in the Master Plan on Aging established pursuant to Executive Order N-14-19.

Governor's Veto Message:

This bill would fund near-zero emission vehicles for transportation to nonemergency medical services for older individuals and disabled persons by allocating Greenhouse Gas Reduction Fund (GGRF) dollars through the Clean Mobility Options program.

While funding additional types of near-zero emission or zero emission vehicles may help the State meet both the goals of reducing greenhouse gas emissions and increasing community access to nonemergency medical service transport, many millions of dollars should be discussed as part of the overall GGRF expenditure plan in the budget.

COMMENTS:

Research shows that lack of adequate transportation can constitute a significant obstacle to healthcare access, especially to individuals with lower incomes or who also lack adequate health insurance. Gaps in transportation can lead to missed health appointments, delayed care, and missed or delayed medication use. These consequences lead to poor health management of chronic illness and thus fragile health. Transportation barriers could trigger more emergency room visits.

According to the Author:

"Providing clean transportation assistance to health care for seniors and those living with disabilities in areas that already have enormous barriers to health care access and, in many cases, live in communities that suffer from poor air quality, would help increase access to care for vulnerable populations while also improving local air quality and reducing overall emissions, thus providing significant health benefits to the populations that live in disadvantaged areas and throughout the state."

Arguments in Support:

The California Commission on Aging writes, "AB 970 would help expand the use of low-emission vehicles in one of the most needed transit areas – non-medical transportation for the elderly and persons with disabilities. Using these dollars this way will help the growing population of older adults and persons with disabilities remain independent while also protecting the environment in the communities where they live."

Arguments in Opposition:

None.

FISCAL COMMENTS:

Ordered to third reading pursuant to Senate Rule 28.8 from Senate Appropriations Committee.

VOTES:

ASM AGING AND LONG-TERM CARE: 7-0-0

YES: Nazarian, Voepel, Boerner Horvath, Kalra, Lackey, Reyes, Blanca Rubio

ASM TRANSPORTATION: 14-1-0

YES: Frazier, Fong, Aguiar-Curry, Berman, Bigelow, Chu, Cunningham, Daly, Diep, Gipson, Grayson, Medina, Nazarian, O'Donnell

NO: Friedman

ASM APPROPRIATIONS: 18-0-0

YES: Gonzalez, Bigelow, Bloom, Bonta, Brough, Calderon, Carrillo, Chau, Diep, Eggman, Fong, Gabriel, Eduardo Garcia, Maienschein, Obernolte, Petrie-Norris, Quirk, Robert Rivas

ASSEMBLY FLOOR: 76-0-4

YES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Choi, Chu, Cooper, Cunningham, Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, O'Donnell, Obernolte, Patterson, Petrie‑Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Voepel, Waldron, Weber, Wicks, Wood, Rendon

ABS, ABST OR NV: Chiu, Cooley, Eduardo Garcia, Ting

SENATE FLOOR: 39-0-1

YES: Allen, Archuleta, Atkins, Bates, Beall, Borgeas, Bradford, Caballero, Chang, Dahle, Dodd, Durazo, Galgiani, Glazer, Lena Gonzalez, Grove, Hertzberg, Hill, Hueso, Hurtado, Jackson, Jones, Leyva, McGuire, Mitchell, Monning, Moorlach, Morrell, Nielsen, Pan, Portantino, Roth, Rubio, Skinner, Stern, Stone, Umberg, Wiener, Wilk

ABS, ABST OR NV: Wieckowski

ASSEMBLY FLOOR: 78-0-1

YES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Petrie-Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Voepel, Waldron, Weber, Wicks, Wood, Rendon

ABS, ABST OR NV: Ting

UPDATED:

VERSION: September 6, 2019

CONSULTANT: Elizabeth Fuller / AGING & L.T.C. / (916) 319-3990 FN: 0002573

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 970

Author:(Salas)

As Amended Ver:August 29, 2019

Majority vote

SUMMARY:

Makes grant awards available under the State Air Resources Board's Clean Mobility Options program for disadvantaged communities and low-income communities to eligible applicants. The grant awards would be used to fund transportation to and from nonemergency medical services for older individuals and persons with a disability, for the purpose of reducing greenhouse gas emissions.

The Senate Amendments:

1. Require the California Department of Aging to hold a public workshop devoted to the topic of overcoming barriers to providing transportation to and from nonemergency medical services for older individuals and persons with a disability on or before July 1, 2020.
2. Require the workshop to include, at a minimum, an identification of existing funding sources for these transportation purposes, including, but not limited to a presentation from the State Air Resources Board on existing state clean transportation incentive programs that could fund these transportation purposes; a presentation from public transit agencies on existing funding options available; a discussion of strategies and options that could be employed to better utilize existing funding sources; and would repeal effective January 1, 2021.
3. Permit the results of the workshop to be considered for inclusion in the Master Plan on Aging established pursuant to Executive Order N-14-19.

COMMENTS:

Research shows that lack of adequate transportation can constitute a significant obstacle to healthcare access, especially to individuals with lower incomes or who also lack adequate health insurance. Gaps in transportation can lead to missed health appointments, delayed care, and missed or delayed medication use. These consequences lead to poor health management of chronic illness and thus fragile health. Transportation barriers could trigger more emergency room visits.

According to the Author:

"Providing clean transportation assistance to health care for seniors and those living with disabilities in areas that already have enormous barriers to health care access and, in many cases, live in communities that suffer from poor air quality, would help increase access to care for vulnerable populations while also improving local air quality and reducing overall emissions, thus providing significant health benefits to the populations that live in disadvantaged areas and throughout the state."

Arguments in Support:

The California Commission on Aging writes, "AB 970 would help expand the use of low-emission vehicles in one of the most needed transit areas – non-medical transportation for the elderly and persons with disabilities. Using these dollars this way will help the growing population of older adults and persons with disabilities remain independent while also protecting the environment in the communities where they live."

Arguments in Opposition:

None.

FISCAL COMMENTS:

Ordered to third reading pursuant to Senate Rule 28.8 from Senate Appropriations Committee.

VOTES:

ASM AGING AND LONG-TERM CARE: 7-0-0

YES: Nazarian, Voepel, Boerner Horvath, Kalra, Lackey, Reyes, Blanca Rubio

ASM TRANSPORTATION: 14-1-0

YES: Frazier, Fong, Aguiar-Curry, Berman, Bigelow, Chu, Cunningham, Daly, Diep, Gipson, Grayson, Medina, Nazarian, O'Donnell

NO: Friedman

ASM APPROPRIATIONS: 18-0-0

YES: Gonzalez, Bigelow, Bloom, Bonta, Brough, Calderon, Carrillo, Chau, Diep, Eggman, Fong, Gabriel, Eduardo Garcia, Maienschein, Obernolte, Petrie-Norris, Quirk, Robert Rivas

ASSEMBLY FLOOR: 76-0-4

YES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Choi, Chu, Cooper, Cunningham, Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, O'Donnell, Obernolte, Patterson, Petrie‑Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Voepel, Waldron, Weber, Wicks, Wood, Rendon

ABS, ABST OR NV: Chiu, Cooley, Eduardo Garcia, Ting

SENATE FLOOR: 39-0-1

YES: Allen, Archuleta, Atkins, Bates, Beall, Borgeas, Bradford, Caballero, Chang, Dahle, Dodd, Durazo, Galgiani, Glazer, Lena Gonzalez, Grove, Hertzberg, Hill, Hueso, Hurtado, Jackson, Jones, Leyva, McGuire, Mitchell, Monning, Moorlach, Morrell, Nielsen, Pan, Portantino, Roth, Rubio, Skinner, Stern, Stone, Umberg, Wiener, Wilk

ABS, ABST OR NV: Wieckowski

UPDATED:

VERSION: August 29, 2019

CONSULTANT: Gail Gronert / AGING & L.T.C. / (916) 319-3990 FN: 0001726

 THIRD READING  

Bill No: AB 970

Author: Salas (D)

Amended: 8/29/19 in Senate

Vote: 21

SENATE HUMAN SERVICES COMMITTEE: 4-0, 6/10/19

AYES: Hurtado, Beall, Pan, Wiener

NO VOTE RECORDED: Stone, Jackson

SENATE ENVIRONMENTAL QUALITY COMMITTEE: 6-0, 7/3/19

AYES: Allen, Bates, Dahle, Hill, Skinner, Stern

NO VOTE RECORDED: Wieckowski

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 76-0, 5/22/19 - See last page for vote

SUBJECT: California Department of Aging: grants: transportation

SOURCE: Author

DIGEST:

This bill makes grant awards available under the State Air Resources Board’s (ARB) Clean Mobility Options program for disadvantaged communities and low-income communities to eligible applicants in order to fund transportation to and from nonemergency medical services for older individuals and persons with disabilities, for purpose of reducing greenhouse gas emissions, as specified. This bill requires the grant funds to be use for the purchase, lease, operation, or maintenance of zero-emission vehicles, or, under specified circumstances, near-zero-emission vehicles, with a capacity for 7 to 15 passengers, inclusive. This bill also requires the California Department of Aging (CDA) to hold a public workshop devoted to the topic of overcoming barriers in providing transportation to and from nonemergency medical services for older individuals and persons with disabilities, as specified.

Senate Floor Amendments of 8/29/19 permit results of a workshop on overcoming barriers to providing transportation to and from nonemergency medical services for older individuals and persons with disabilities to be considered for inclusion in the Master Plan on Aging.

ANALYSIS:

Existing federal law:

1. Establishes, in federal law, the Older Americans Act (OAA), which promotes the well-being of Americans 60 years old and older through services and programs designed to meet the specific needs of older citizens. Services provided under the Older Americans Act include home-delivered and communal meals; family caregiver support; health services home assistance for the elderly; job training and volunteer opportunities; and protections from elder abuse (42 U.S. Code 3001, et seq.)
2. Requires the state, in order to be eligible for grants for certain programs within the Older Americans Act, to designate area agencies on aging (AAAs) to serve older adults within a planning and service area and sets other requirements for AAAs, as specified. (42 U.S. Code 3025, et seq.)

Existing state law:

1. Requires the ARB, under the California Global Warming Solutions Act of 2006 (also known as AB 32), to adopt a greenhouse gas (GHG) emissions limits equivalent to 1990 levels by 2020 and to use market-based mechanisms (cap-and-trade) to achieve compliance with these regulations. (HSC 38500 et seq.)
2. Establishes the greenhouse gas fund. (GOV 16428.8)
3. Requires ARB to ensure that statewide GHG emissions are reduced to at least 40 percent below 1990 levels by 2030. (HSC 38566)
4. Creates the CDA and sets the department’s mission to provide leadership to the AAAs in developing systems of home- and community-based services that maintain individuals in their own homes or least restrictive homelike environments. (WIC 9100 et seq.)
5. Declares that the Legislature recognizes the AAAs to be the local units on aging in California that are supported from an array of sources, including federal funding largely through the federal OAA state and local governmental assistance, the private sector, and individual contributions for services. (WIC 9400)
6. Requires AAAs to create a plan for delivery of services based on needs and that each plan shall include developing area home- and community-based systems of care that maintain individuals in their own homes or least restrictive environment, providing better access to these services through information and referral, outreach, and transportation, and advocating for the elderly on local, state, and national levels. (WIC 9400 (d)(1))  
7. Establishes the Medi-Cal program, administered by DHCS, under which qualified low-income persons receive health care benefits and, in part, governed and funded by federal Medicaid program provisions. (WIC 14000 et seq.)
8. Establishes a schedule of benefits under the Medi-Cal program, which includes medical transportation services, subject to utilization controls, and in-home medical care services when medically appropriate and subject to utilization controls, for beneficiaries who would otherwise require care for an extended period of time in an acute care hospital at a cost higher than in-home medical care services. Included within the definition of in-home medical care services are emergency and non-emergency medical transportation (NMT). (WIC 141321 et seq.)
9. Defines non-emergency transportation services, for purposes of the Medi-Cal Program, to include, at a minimum, round trip transportation for a beneficiary to obtain covered Medi-Cal services by passenger car, taxicab, or any other form of public or private conveyance, and mileage reimbursement when conveyance is in a private vehicle arranged by the beneficiary and not through a transportation broker, bus passes, taxi vouchers, or train tickets. (WIC 14132)

This bill:

1. States that “near-zero-emission vehicle” and “zero-emission vehicle” have the same meanings as those terms are defined in current law within the Charge Ahead California Initiative, a specified.
2. Requires that grant awards for projects to provide transportation to and from nonemergency medical services for older individuals and persons with disabilities, as specified, shall be available under the State Air Resources Board’s Clean Mobility Options program for disadvantaged communities and low-income communities for the purpose of reducing greenhouse gas emissions.
3. Provides that eligible applicants who may apply for such grants shall include, but not be limited to, all of the following:
4. Local or regional transportation agencies that provide transportation services to seniors and persons with disabilities;
5. Area agencies on aging;
6. Counties; and
7. Public transit operators.
8. Requires an applicant that has been awarded a grant shall use the funds to provide transportation services as described below:
9. Eligible transportation includes transportation to and from nonemergency medical services for older individuals and persons with disabilities, as specified.
10. Eligible transportation shall be made available using the purchase, lease, operation, or maintenance of zero-emission vehicles with a capacity for 7 to 15 passengers, inclusive. Near-zero-emission vehicles shall be eligible if zero-emission options are not available.
11. Permits an applicant that has been awarded a grant to use grant moneys to cover reasonable administrative costs incurred by the applicant.
12. Permits moneys from the Greenhouse Gas Reduction Fund to be allocated, upon appropriation by the Legislature, to fund the grant program.
13. Requires the CDA to, on or before July 1, 2020, hold a public workshop devoted to the topic of overcoming barriers to providing transportation to and from nonemergency medical services for older individuals and persons with disabilities.
14. Requires the workshop to include, at a minimum, an identification of existing funding sources for these transportation purposes, including, but not limited to, all of the following:
15. A presentation from the ARB on existing state clean transportation incentive programs that could fund these transportation purposes.
16. A presentation from public transit agencies on all existing funding options available to them that could fund these transportation purposes.
17. A discussion of strategies and options that could be employed to better utilize existing funding sources to fund these transportation purposes.
18. Permits the results of the workshop to be considered for inclusion in the Master Plan for Aging.
19. States that provisions of the bill shall remain in effect only until January 1, 2021, and as of that date are repealed.

Background

According to the author, “California has many seniors and people with disabilities who suffer from chronic, serious illnesses that limit their mobility in communities throughout the state. Resources for non-emergency medical transportation are limited in many communities and, where they are available, the vehicles used in those communities use fuels that contribute to air pollution. Significantly, these disadvantages that contribute to a lack of access the health care result in higher morbidity and mortality rates. Addressing geographic distance and transportation difficulties for elderly and disabled patients is a cost-effective way of improving the quality of life and health outcomes for vulnerable populations, while utilizing zero-emission or near-zero emission vehicles to reduce transportation barriers provides the important co-benefit of improving local air quality and reducing emissions.”

In Traveling Towards Disease: Transportation Barriers to Health Care Access, (Syed, Gerber and Sharp. October 2013) the authors examined 61 peer-reviewed studies on transportation barriers to healthcare access. Overall, the studies found that transportation barriers are an important barrier to healthcare access, particularly to persons with lower incomes or are under insured or uninsured. Transportation barriers can lead to rescheduled or missed health appointments, delayed care, and missed or delayed medication use. These consequences may lead to poor health management of chronic illness and thus poorer health outcomes. Ultimately, transportation barriers may mean the difference between worse clinical outcomes that could trigger more emergency room visits and timely care that can lead to improved outcomes.

California Department of Aging and Area Agencies on Aging

CDA administers programs that serve older adults, adults with disabilities, family caregivers, and residents in long-term care facilities throughout the state. CDA administers funds allocated under the federal OAA, the Older Californians Act, and through the Medi-Cal Program. CDA works with the state’s 33 AAAs to assist them in leveraging federal OAA Title IIIB Supportive Services Program resources that can be used to provide a variety of transportation services. AAAs can use these funds for assisted transportation (typically provided door-to-door from home to service) and general transportation services (typically through vouchers, transit passes, volunteer transportation assistance, and transportation to congregate meal sites). In fiscal year 2018-19, 79 percent of the AAAs fund general transportation services and 30 percent fund assisted transportation services.

Master Plan for Aging

On June 10, 2019, Governor Newsom signed Executive Order N-14-19, which calls for the establishment of a Master Plan for Aging by October 1, 2020 that will “serve as a blueprint for state government, local government, private sector, and philanthropy to implement strategies and partnerships that promote healthy aging and prepare the state for the coming demographic changes.” This executive order directs the Secretary of the Health and Human Services Agency to convene a Cabinet-level Workgroup for Aging to advise the Secretary in developing and issuing the Master Plan, and directs the Agency to convene a Master Plan for Aging Stakeholder Advisory Committee, to include a Research Subcommittee and a Long-Term Care Subcommittee representing a broad range of Californians with an interest in building an age-friendly California. The Long-Term Care Subcommittee is directed to report to the Governor by March 2020 on a number of factors related to LTSS.

Air Resources Board

The ARB has invested in multiple grant programs for the purpose of reducing greenhouse gas emissions. Among these are the Car-Sharing and Mobility Options Pilot Program which provides funding for government entities or non-profit organizations to start or expand car share and mobility programs for residents in disadvantaged communities. Additionally, the ARB has created the Hybrid and Zero-Emission Truck and Bus Voucher Incentive Project and the Low NOx Engine Incentive Program. For commercial vehicles, ARB provides grants up to $300,000 for the purchase or lease of a zero-emission truck or bus and up to $9,000 for eligible hybrid trucks and buses. A variety of buses are eligible for vouchers, including school, transit, commercial and shuttle buses. In addition, the Clean Vehicle Rebate Program provides up to $7,000 to California residents who purchase or leases a new near-zero or zero-emission vehicle. Public fleets are eligible to receive up to 30 rebates per calendar year.

ARB’s Clean Mobility Options for Disadvantaged Communities Program provides funding for government entities or non-profit organizations to start or expand car share and mobility programs for residents of DACs. The Lift Line Paratransit Dial-a-Ride Program under this program funds ZEVs for nonemergency medical services (medical appointments) and meal site transportation for elderly and disabled individuals. According to ARB, two 16-seat ZEV shuttles (including ADA Wheelchair lifts) for Lift Line service have already been funded from this program. This bill makes these grant funds available to disadvantaged and low-income communities to fund transportation to and from nonemergency medical services for older individuals and persons with a disability, for purpose of reducing greenhouse gas emissions

Related/Prior Legislation

AB 2877 (Mathis, 2018) would have required ARB to provide grants to rural counties for the purchase, operation and maintenance of NZEVs and ZEVs and required these counties to provide seniors and the disabled with non-emergency transportation services using these vehicles. This bill did not pass out of Assembly Appropriations Committee.

AB 398 (E. Garcia, Chapter 135, Statutes of 2017) among other things, extended cap-and-trade provisions until December 31, 2030.

AB 2394 (E. Garcia, Chapter 615, Statutes of 2016) required the Medi-Cal program to cover nonemergency medical transportation for a beneficiary to obtain covered Medi-Cal services.

SB 32 (Pavley, Chapter 249, Statutes of 2016) required ARB to ensure that statewide GHG emissions are reduced at least 40 percent below 1990 levels by 2030.

SB 1275 (de León, Chapter 530, Statutes of 2014) established the Charge Ahead Initiative, to provide incentives to increase the availability of ZEVs and NZEVs, particularly to low-income and moderate-income consumers and disadvantaged communities.

AB 32 (Núñez, Chapter 488, Statutes of 2006) required ARB to develop a plan of how to reduce emissions to 1990 levels by the year 2020, authorized cap-and-trade and also required ARB to ensure that, to the extent feasible, GHGs reduction requirement and programs direct public and private investment toward the most disadvantaged communities.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 8/29/19)

None received

OPPOSITION: (Verified 8/29/19)

None received

ASSEMBLY FLOOR: 76-0, 5/22/19

AYES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Choi, Chu, Cooper, Cunningham, Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Petrie-Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Voepel, Waldron, Weber, Wicks, Wood, Rendon

NO VOTE RECORDED: Chiu, Cooley, Eduardo Garcia, Ting

Prepared by: Taryn Smith / HUMAN S. /

8/30/19 15:25:18

**** END ****

 THIRD READING  

Bill No: AB 970

Author: Salas (D)

Amended: 7/5/19 in Senate

Vote: 21

SENATE HUMAN SERVICES COMMITTEE: 4-0, 6/10/19

AYES: Hurtado, Beall, Pan, Wiener

NO VOTE RECORDED: Stone, Jackson

SENATE ENVIRONMENTAL QUALITY COMMITTEE: 6-0, 7/3/19

AYES: Allen, Bates, Dahle, Hill, Skinner, Stern

NO VOTE RECORDED: Wieckowski

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 76-0, 5/22/19 - See last page for vote

SUBJECT: California Department of Aging: grants: transportation

SOURCE: Author

DIGEST:

This bill makes grant awards available under the State Air Resources Board’s (ARB) Clean Mobility Options program for disadvantaged communities and low-income communities to eligible applicants in order to fund transportation to and from nonemergency medical services for older individuals and persons with a disability, for purpose of reducing greenhouse gas emissions, as specified. This bill requires the grant funds to be use for the purchase, lease, operation, or maintenance of zero-emission vehicles, or, under specified circumstances, near-zero-emission vehicles, with a capacity for 7 to 15 passengers, inclusive. This bill also requires the California Department of Aging (CDA) to hold a public workshop devoted to the topic of overcoming barriers in providing transportation to and from nonemergency medical services for older individuals and persons with a disability, as specified.

ANALYSIS:

Existing federal law:

1. Establishes, in federal law, the Older Americans Act (OAA), which promotes the well-being of Americans 60 years old and older through services and programs designed to meet the specific needs of older citizens. Services provided under the Older Americans Act include home-delivered and communal meals; family caregiver support; health services home assistance for the elderly; job training and volunteer opportunities; and protections from elder abuse (42 U.S. Code 3001, et seq.)
2. Requires the state, in order to be eligible for grants for certain programs within the Older Americans Act, to designate area agencies on aging (AAAs) to serve older adults within a planning and service area and sets other requirements for AAAs, as specified. (42 U.S. Code 3025, et seq.)

Existing state law:

1. Requires the ARB, under the California Global Warming Solutions Act of 2006 (also known as AB 32), to adopt a greenhouse gas (GHG) emissions limits equivalent to 1990 levels by 2020 and to use market-based mechanisms (cap-and-trade) to achieve compliance with these regulations. (HSC 38500 et seq.)
2. Establishes the greenhouse gas fund. (GOV 16428.8)
3. Requires ARB to ensure that statewide GHG emissions are reduced to at least 40 percent below 1990 levels by 2030. (HSC 38566)
4. Creates the CDA and sets the department’s mission to provide leadership to the AAAs in developing systems of home- and community-based services that maintain individuals in their own homes or least restrictive homelike environments. (WIC 9100 et seq.)
5. Declares that the Legislature recognizes the AAAs to be the local units on aging in California that are supported from an array of sources, including federal funding largely through the federal OAA state and local governmental assistance, the private sector, and individual contributions for services. (WIC 9400)
6. Requires AAAs to create a plan for delivery of services based on needs and that each plan shall include developing area home- and community-based systems of care that maintain individuals in their own homes or least restrictive environment, providing better access to these services through information and referral, outreach, and transportation, and advocating for the elderly on local, state, and national levels. (WIC 9400 (d)(1))  
7. Establishes the Medi-Cal program, administered by DHCS, under which qualified low-income persons receive health care benefits and, in part, governed and funded by federal Medicaid program provisions. (WIC 14000 et seq.)
8. Establishes a schedule of benefits under the Medi-Cal program, which includes medical transportation services, subject to utilization controls, and in-home medical care services when medically appropriate and subject to utilization controls, for beneficiaries who would otherwise require care for an extended period of time in an acute care hospital at a cost higher than in-home medical care services. Included within the definition of in-home medical care services are emergency and non-emergency medical transportation (NMT). (WIC 141321 et seq.)
9. Defines non-emergency transportation services, for purposes of the Medi-Cal Program, to include, at a minimum, round trip transportation for a beneficiary to obtain covered Medi-Cal services by passenger car, taxicab, or any other form of public or private conveyance, and mileage reimbursement when conveyance is in a private vehicle arranged by the beneficiary and not through a transportation broker, bus passes, taxi vouchers, or train tickets. (WIC 14132)

This bill:

1. States that “near-zero-emission vehicle” and “zero-emission vehicle” have the same meanings as those terms are defined in current law within the Charge Ahead California Initiative, a specified.
2. Requires that grant awards for projects to provide transportation to and from nonemergency medical services for older individuals and persons with a disability, as specified, shall be available under the State Air Resources Board’s Clean Mobility Options program for disadvantaged communities and low-income communities for the purpose of reducing greenhouse gas emissions.
3. Provides that eligible applicants who may apply for such grants shall include, but not be limited to, all of the following:
4. Local or regional transportation agencies that provide transportation services to seniors and persons with disabilities;
5. Area agencies on aging;
6. Counties; and
7. Public transit operators.
8. Requires an applicant that has been awarded a grant shall use the funds to provide transportation services as described below:
9. Eligible transportation includes transportation to and from nonemergency medical services for older individuals and persons with a disability, as specified.
10. Eligible transportation shall be made available using the purchase, lease, operation, or maintenance of zero-emission vehicles with a capacity for 7 to 15 passengers, inclusive. Near-zero-emission vehicles shall be eligible if zero-emission options are not available.
11. Permits an applicant that has been awarded a grant to use grant moneys to cover reasonable administrative costs incurred by the applicant.
12. Permits moneys from the Greenhouse Gas Reduction Fund to be allocated, upon appropriation by the Legislature, to fund the grant program.
13. Requires the CDA to, on or before December 31, 2020, hold a public workshop devoted to the topic of overcoming barriers to providing transportation to and from nonemergency medical services for older individuals and persons with a disability.
14. Requires the workshop to include, at a minimum, an identification of existing funding sources for these transportation purposes, including, but not limited to, all of the following:
15. A presentation from the ARB on existing state clean transportation incentive programs that could fund these transportation purposes.
16. A presentation from public transit agencies on all existing funding options available to them that could fund these transportation purposes.
17. A discussion of strategies and options that could be employed to better utilize existing funding sources to fund these transportation purposes.
18. States that provisions of the bill shall remain in effect only until January 1, 2021, and as of that date are repealed.

Background

According to the author, “California has many seniors and people with disabilities who suffer from chronic, serious illnesses that limit their mobility in communities throughout the state. Resources for non-emergency medical transportation are limited in many communities and, where they are available, the vehicles used in those communities use fuels that contribute to air pollution. Significantly, these disadvantages that contribute to a lack of access the health care result in higher morbidity and mortality rates. Addressing geographic distance and transportation difficulties for elderly and disabled patients is a cost-effective way of improving the quality of life and health outcomes for vulnerable populations, while utilizing zero-emission or near-zero emission vehicles to reduce transportation barriers provides the important co-benefit of improving local air quality and reducing emissions.”

In Traveling Towards Disease: Transportation Barriers to Health Care Access, (Syed, Gerber and Sharp. October 2013) the authors examined 61 peer-reviewed studies on transportation barriers to healthcare access. Overall, the studies found that transportation barriers are an important barrier to healthcare access, particularly to persons with lower incomes or are under insured or uninsured. Transportation barriers can lead to rescheduled or missed health appointments, delayed care, and missed or delayed medication use. These consequences may lead to poor health management of chronic illness and thus poorer health outcomes. Ultimately, transportation barriers may mean the difference between worse clinical outcomes that could trigger more emergency room visits and timely care that can lead to improved outcomes.

California Department of Aging and Area Agencies on Aging

CDA administers programs that serve older adults, adults with disabilities, family caregivers, and residents in long-term care facilities throughout the state. CDA administers funds allocated under the federal OAA, the Older Californians Act, and through the Medi-Cal Program. CDA works with the state’s 33 AAAs to assist them in leveraging federal OAA Title IIIB Supportive Services Program resources that can be used to provide a variety of transportation services. AAAs can use these funds for assisted transportation (typically provided door-to-door from home to service) and general transportation services (typically through vouchers, transit passes, volunteer transportation assistance, and transportation to congregate meal sites). In fiscal year 2018-19, 79 percent of the AAAs fund general transportation services and 30 percent fund assisted transportation services.

Air Resources Board

The ARB has invested in multiple grant programs for the purpose of reducing greenhouse gas emissions. Among these are the Car-Sharing and Mobility Options Pilot Program which provides funding for government entities or non-profit organizations to start or expand car share and mobility programs for residents in disadvantaged communities. Additionally, the ARB has created the Hybrid and Zero-Emission Truck and Bus Voucher Incentive Project and the Low NOx Engine Incentive Program. For commercial vehicles, ARB provides grants up to $300,000 for the purchase or lease of a zero-emission truck or bus and up to $9,000 for eligible hybrid trucks and buses. A variety of buses are eligible for vouchers, including school, transit, commercial and shuttle buses. In addition, the Clean Vehicle Rebate Program provides up to $7,000 to California residents who purchase or leases a new near-zero or zero-emission vehicle. Public fleets are eligible to receive up to 30 rebates per calendar year.

ARB’s Clean Mobility Options for Disadvantaged Communities Program provides funding for government entities or non-profit organizations to start or expand car share and mobility programs for residents of DACs. The Lift Line Paratransit Dial-a-Ride Program under this program funds ZEVs for nonemergency medical services (medical appointments) and meal site transportation for elderly and disabled individuals. According to ARB, two 16-seat ZEV shuttles (including ADA Wheelchair lifts) for Lift Line service have already been funded from this program. This bill makes these grant funds available to disadvantaged and low-income communities to fund transportation to and from nonemergency medical services for older individuals and persons with a disability, for purpose of reducing greenhouse gas emissions

Related/Prior Legislation

AB 2877 (Mathis, 2018) would have required ARB to provide grants to rural counties for the purchase, operation and maintenance of NZEVs and ZEVs and required these counties to provide seniors and the disabled with non-emergency transportation services using these vehicles. This bill did not pass out of Assembly Appropriations Committee.

AB 398 (E. Garcia, Chapter 135, Statutes of 2017) among other things, extended cap-and-trade provisions until December 31, 2030.

AB 2394 (E. Garcia, Chapter 615, Statutes of 2016) required the Medi-Cal program to cover nonemergency medical transportation for a beneficiary to obtain covered Medi-Cal services.

SB 32 (Pavley, Chapter 249, Statutes of 2016) required ARB to ensure that statewide GHG emissions are reduced at least 40 percent below 1990 levels by 2030.

SB 1275 (de León, Chapter 530, Statutes of 2014) established the Charge Ahead Initiative, to provide incentives to increase the availability of ZEVs and NZEVs, particularly to low-income and moderate-income consumers and disadvantaged communities.

AB 32 (Núñez, Chapter 488, Statutes of 2006) required ARB to develop a plan of how to reduce emissions to 1990 levels by the year 2020, authorized cap-and-trade and also required ARB to ensure that, to the extent feasible, GHGs reduction requirement and programs direct public and private investment toward the most disadvantaged communities.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 8/12/19)

Contra Costa County

OPPOSITION: (Verified 8/12/19)

None received

ASSEMBLY FLOOR: 76-0, 5/22/19

AYES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Choi, Chu, Cooper, Cunningham, Dahle, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Petrie-Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Voepel, Waldron, Weber, Wicks, Wood, Rendon

NO VOTE RECORDED: Chiu, Cooley, Eduardo Garcia, Ting

Prepared by: Taryn Smith / HUMAN S. /

8/14/19 14:53:41

**** END ****

SENATE COMMITTEE ON ENVIRONMENTAL QUALITY

Senator Allen, Chair

2019 - 2020 Regular

Bill No: AB 970

SUBJECT: California Department of Aging: grants: transportation.

DIGEST: This bill would require the California Department of Aging (CDA) to administer a grant program to fund transportation to and from nonemergency medical services for older individuals and persons with a disability for the purpose of reducing greenhouse gas (GHG) emissions.

ANALYSIS:

Existing law:

1. Requires the California Air Resources Board (ARB), pursuant to California Global Warming Solutions Act of 2006 (AB 32 Núñez, Chapter 488, Statutes of 2006), to adopt a GHG emissions limit equivalent to 1990 levels by 2020 and to use market-based mechanisms (cap-and-trade) to achieve compliance with these regulations.
2. Requires, pursuant to SB 32 (Pavley Chapter 249, Statutes of 2016), that ARB ensure that statewide GHG emissions are reduced to at least 40% below 1990 levels by 2030.
3. Establishes the Greenhouse Gas Reduction Fund (GGRF) in the State Treasury, requires all moneys, except for fines and penalties, collected pursuant to cap-and-trade be deposited in the fund and requires the Department of Finance, in consultation with ARB and any other relevant state agency, to develop, as specified, an investment plan for the moneys deposited in the GGRF, and makes the GGRF funds available for appropriation by the Legislature.
4. Requires CDA to designate various private nonprofit or public agencies as Area Agencies on Aging (AAAs) to work for the interests of older Californians within a planning and service area and provide a broad array of social and nutritional services.
5. States that the mission of CDA is to provide leadership to the AAAs in developing systems of home-and community-based services that maintain individuals in their own homes or the least restrictive homelike environments.
6. Establishes the Medi-Cal program under which qualified low-income persons receive health care benefits and, in part, governed and funded by federal Medicaid program provisions.
7. Defines non-emergency transportation services, for purposes of the Medi-Cal Progam, to include, at a minimum, round trip transportation for a beneficiary to obtain covered Medi-Cal services by passenger car, taxicab, or any other form of public or private conveyance, and mileage reimbursement when conveyance is in a private vehicle arranged by the beneficiary and not through a transportation broker, bus passes, taxi vouchers, or train tickets.
8. Establishes the Charge Ahead California Initiative pursuant to SB 1275 (de León), Chapter 530, Statutes of 2014, that, among other things, includes the goal of placing at least one million zero-emission vehicles (ZEVs) and near-zero-emission vehicles (NZEVs) into service by January 1, 2023, and increasing access to these vehicles for disadvantaged, low-and- moderate-income communities and consumers.
   

This bill:

1. Requires CDA, in coordination with ARB and the Department of Healthcare Services, to administer a grant program for the purchase, lease, operation or maintenance of ZEVs and NZEVs to provide seniors and the disabled with non-emergency transportation services.
2. Requires grant recipients to provide seniors and the disabled with non-emergency transportation services using these vehicles in order to reduce GHG emissions.
3. Authorizes, but does not limit, eligibility to the following entities:
   1. Local or regional transportation agencies that provide transportation services to seniors and person with disabilities;
   2. AAAs;
   3. Counties;
   4. Public transit operators.
4. Requires grant recipients to provide transportation services using the purchase, lease, operation or maintenance of ZEVs or NZEVs with a capacity for seven, 12 or 15 passengers.
5. Authorizes moneys from the GGRF to be used to fund the grant program, upon appropriation by the Legislature.
   

Background

1. California Department of Aging. CDA administers programs that serve older adults, adults with disabilities, family caregivers, and residents in long-term care facilities throughout the state. CDA administers funds allocated under the federal Older Americans Act (OAA), the Older Californians Act, and through the Medi-Cal program. CDA does not currently operate transportation-related programs explicitly analogous to those specified in this bill. However, it does work with the state’s 33 AAAs to assist them in leveraging federal OAA Title IIIB Supportive Services Program resources that can be used by the AAAs to provide a variety of transportation services for eligible older adults.
   
2. Medi-Cal. The federal government authorizes the Medi-Cal program (which may provide service for the elderly and disabled) to specifically cover non-emergency medical transportation services. To clarify and align the state with this authorization, AB 2394 (E. Garcia Chapter 615, Statutes of 2016), required Medi-Cal to cover non-medical transportation for a beneficiary to obtain covered Medi-Cal services. Non-emergency medical transportation is provided when necessary to obtain program covered medical services and when the beneficiary's medical and physical condition is such that transport by ordinary means of private or public conveyance is not feasible.

Comments

1. Purpose of Bill. According to the author, “California has many seniors and people with disabilities who suffer from chronic, serious illnesses that limit their mobility in communities throughout the state. Resources for non-emergency medical transportation are limited in many communities, and, where they are available, the vehicles used in those communities use fuels that contribute to air pollution. Significantly, these disadvantages that contribute to a lack of access to health care result in higher morbidity and mortality rates. Addressing geographic distance and transportation difficulties for elderly and disabled patients is a cost-effective way of improving the quality of life and health outcomes for vulnerable populations, while utilizing zero-emission or near-zero emission vehicles to reduce transportation barriers provides the important co-benefit of improving local air quality and reducing emissions.”
2. Optimal investment for reducing GHGs? According to a study entitled Traveling Towards Disease: Transportation Barriers to Health Care Access, it was noted that “Millions of Americans face transportation barriers…Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes.”

While it is a laudable goal to provide seniors and people with disabilities with sufficient transportation services to meet their needs, it is unclear whether investing in the types of vehicles targeted in this bill is the optimal use of funds intended to reduce GHGs and reach the state’s ambitious climate goals. ZEV incentive programs should try to optimize GHG reductions from the highest polluting sources, while also targeting new technologies that have the highest potential for market penetration. In practice, this might mean the most cost-effective public investment for reducing GHGs would be to target the replacement of heavy, high mileage, high-volume diesel vehicles. It is unclear if the vehicles targeted in this bill meet this criteria.

1. Existing ZEV and NZEV incentive programs. Currently, there are several programs that provide funding for ZEVs and NZEVs. These programs include:
   1. ARB’s Hybrid and Zero-Emission Truck and Bus Voucher Incentive Project (HVIP). For commercial vehicles, ARB provides grants of up to $300,000 for the purchase or lease of a zero-emission truck or bus and up to $9,000 for eligible hybrid trucks and buses. A variety of buses are available for HVIP vouchers, including school buses, transit buses, commercial buses, and shuttle buses. According to ARB, 160 vouchers have been requested from HVIP totaling over $13 million for ZEV shuttle buses.
   2. ARB’s Clean Mobility Options for Disadvantaged Communities (DAC) Program. Provides funding for government entities or non-profit organizations to start or expand car share and mobility programs for residents of DACs. The Lift Line Paratransit Dial-a-Ride Program under this program funds ZEVs for nonemergency medical services (medical appointments) and meal site transportation for elderly and disabled individuals. According to ARB, two 16-seat ZEV shuttles (including ADA Wheelchair lifts) for Lift Line service have already been funded from this program.
   3. ARB’s Clean Vehicle Rebate Program (CVRP). Provides up to $7,000 to California residents who purchase or lease a new NZEV or ZEV. Private and public entities can access rebates through the CVRP and public fleets are eligible to receive up to 30 rebates per calendar year.
   4. ARB’s Enhanced Fleet Modernization Program (EFMP)/Clean Cars 4 All Program. Incentives for disadvantaged communities to purchase a new or used hybrid, plug-in hybrid, or ZEV.
   5. ARB’s Financing Assistance for Lower-Income Consumers. Provides low-interest loans and vehicle price buy-downs to consumers for the purchase of plug-in hybrid and battery electric vehicles. Also includes a loan loss reserve to encourage lender participation.
   6. The California Energy Commission’s (CEC) Alternative and Renewable Fuels and Vehicle Technology Program. Invests in the adoption of advanced technology vehicles, including ZEV and NZEV medium- and heavy-duty vehicles.
   7. Strategic Growth Council’s Transformative Climate Communities. This program could include funding for ZEVs if these vehicles were part of a targeted community strategy or project to reduce GHGs and local air pollution.
   8. Caltrans’ Low Carbon Transit Operations Program. Provides operating and capital assistance for transit agencies to reduce GHG emissions and improve mobility, with a priority on serving disadvantaged communities.
2. Challenges with program duplication. The Legislative Analyst’s Office’s (LAO) December 2018 report “Assessing California's Climate Policies—Transportation” highlighted how program duplication and overlap can lead to inefficiencies. Specifically, the LAO report mentioned program duplication can lead to the following challenges:
   1. Difficulty in evaluating programs. Interactions between overlapping programs make it difficult to evaluate the effectiveness of each individual program.
   2. Lack of coordination. The existence of multiple programs and administering agencies can make state coordination difficult.
   3. Reduced effectiveness from consumer confusion. Multiple programs could create confusion among potential program recipients, leading to reduced program utilization and effectiveness.
   4. Increased administrative costs. More programs tends to increase administrative overhead costs.
3. Avoid program duplication. Creating another new ZEV incentive program could potentially exasperate the program duplication challenges mentioned previously. Rather than creating a new program, it might be more administratively efficient and effective to embed the proposed program into an existing program that already provides funding for the vehicles targeted in this bill.

Rather than creating another new ZEV incentive program, the Committee may instead wish to amend the bill to embed the proposed program into ARB’s existing Clean Mobility Options for DACs Program.

1. Prioritize ZEVs. SB 1275 established a statutory goal of placing at least one million ZEVs and NZEVs into service by January 1, 2023. However, when feasible, prioritizing ZEVs for public investment will likely result in greater public benefits.

The Committee may wish to amend the bill to only allow funding for NZEVs when ZEV options are not available.

1. Public workshop would be beneficial. This bill is attempting to achieve two goals; (1) meet transportation needs, and (2) do so with clean vehicles that also reduce emissions. A lack of funding appears to be a major challenge to providing the transportation needs identified in this bill. However, it is unclear what the required funding level is to meet these needs, and what funding sources are currently available for these purposes. To provide more insight into the scope of the challenge, as well as available solutions, convening a coordinated public workshop would likely be effective. Some helpful topics that could be discussed in the workshop include:
   1. What are the challenges to providing older individuals and persons with a disability transportation to and from nonemergency medical services? What are the required funding levels needed to address this challenge?
   2. Which existing programs are the vehicles targeted in this bill already eligible to receive funding from?
   3. What educational outreach strategies could be used to promote better utilization of existing funding sources for these types of vehicles?
   4. Which existing programs could be modified to allow funding for these types of vehicles?

The Committee may wish to amend the bill to require DOA to hold a public workshop to explore challenges, solutions, and existing funding sources to strategically and effectively meet the transportation needs targeted in the bill.

Related/Prior Legislation

AB 2877 (Mathis of 2018) would have required ARB to provide grants to rural counties for the purchase, operation and maintenance of NZEVs and ZEVs and required these counties to provide seniors and the disabled with non-emergency transportation services using these vehicles. AB 2877 was held on the suspense file of the Assembly Appropriations Committee.

AB 398 (E. Garcia Chapter 135, Statutes of 2017) among other things, extended cap-and-trade provisions until December 31, 2030.

AB 2394 (E. Garcia Chapter 615, Statutes of 2016) required the Medi-Cal program to cover non-emergency medical transportation for a beneficiary to obtain covered Medi-Cal services.

SB 1275 (de León Chapter 530, Statutes of 2014) established the Charge Ahead Initiative, to provide incentives to increase the availability of ZEVs and NZEVs, particularly to low-income and moderate-income consumers and disadvantaged communities.

AB 32 (Núñez Chapter 488, Statutes of 2006) required ARB to develop a plan of how to reduce emissions to 1990 levels by the year 2020, authorized cap-and-trade and also required ARB to ensure that, to the extent feasible, GHGs reduction requirement and programs direct public and private investment toward the most disadvantaged communities.

DOUBLE REFERRAL:

This measure was heard in Senate Human Services Committee on June 10, 2019, and passed out of committee with a vote of 4-0.

SOURCE:

California Senior Legislature

SUPPORT:

California Commission on Aging

California Senior Legislature

Contra Costa County Board of Supervisors

Imperial County Area Agency on Aging and Public Administration

OPPOSITION:

Sierra Club

ARGUMENTS IN SUPPORT:

According to the California Commission on Aging, “AB 970 makes GGRF funds available to help expand local use of low-emission vehicles in one of the most needed transit areas – non-medical transportation for the elderly and persons with disabilities. Using these dollars this way will help the growing population of older adults and persons with disabilities remain independent while also protecting the environment in the communities where they live.”

ARGUMENTS IN OPPOSITION:

According to the Sierra Club, “AB 970 would provide clean transportation assistance for seniors and those living with disabilities, which we agree is very important. However, the legislation currently states that the CDA would receive GGRF appropriations for ZEVs and NZEVs. Only ZEVs should be eligible for the GGRF appropriations. We would remove our opposition if the reference to NZEVs was omitted.”

-- END --

SENATE COMMITTEE ON HUMAN SERVICES

Senator Hurtado, Chair

2019 - 2020 Regular

Subject: California Department of Aging: grants: transportation.

SUMMARY

This bill requires the California Department of Aging (CDA), in coordination with the Air Resources Board (ARB) and the Department of Health Care Services (DHCS), to administer a grant program to fund transportation to and from nonemergency medical services for older individuals and persons with disabilities through the purchase, lease operation or maintenance of specified zero-emission vehicles (ZEVs) and near-zero emission vehicles (NZEVs).

ABSTRACT

Existing Law:

1. Requires the ARB, under the California Global Warming Solutions Act of 2006 (also known as AB 32), to adopt a greenhouse gas (GHG) emissions limits equivalent to 1990 levels by 2020 and to use market-based mechanisms (cap-and-trade) to achieve compliance with these regulations. (HSC 38500 et seq.)
2. Establishes the greenhouse gas fund. (GOV 16428.8)
3. Requires ARB to ensure that statewide GHG emissions are reduced to at least 40 percent below 1990 levels by 2030. (HSC 38566)
4. Establishes, in federal law, the Older Americans Act (OAA), which promotes the well-being of Americans 60 years old and above through services and programs designed to meet the specific needs of older citizens. Services provided under the Older Americans Act include home-delivered and communal meals; family caregiver support; health services home assistance for the elderly; job training and volunteer opportunities; and protections from elder abuse (42 U.S. Code 3001, et seq.)
5. Requires the state, in order to be eligible for grants for certain programs within the Older Americans Act, to designate area agencies on aging (AAAs) to serve older adults within a planning and service area and sets other requirements for AAAs, as specified. (42 U.S. Code 3025, et seq.)
6. Creates the CDA and sets the department’s mission to provide leadership to the AAAs in developing systems of home- and community-based services that maintain individuals in their own homes or least restrictive homelike environments. (WIC 9100 et seq.)
7. Declares that the Legislature recognizes the AAAs to be the local units on aging in California that are supported from an array of sources, including federal funding largely through the federal OAA state and local governmental assistance, the private sector, and individual contributions for services. (WIC 9400)
8. Requires AAAs to create a plan for delivery of services based on needs and that each plan shall include developing area home- and community-based systems of care that maintain individuals in their own homes or least restrictive environment, providing better access to these services through information and referral, outreach, and transportation, and advocating for the elderly on local, state, and national levels. (WIC 9400 (d)(1))  
9. Establishes the Medi-Cal program, administered by DHCS, under which qualified low-income persons receive health care benefits and, in part, governed and funded by federal Medicaid program provisions. (WIC 14000 et seq.)
10. Establishes a schedule of benefits under the Medi-Cal program, which includes medical transportation services, subject to utilization controls, and in-home medical care services when medically appropriate and subject to utilization controls, for beneficiaries who would otherwise require care for an extended period of time in an acute care hospital at a cost higher than in-home medical care services. Included within the definition of in-home medical care services are emergency and non-emergency medical transportation (NMT). (WIC 141321 et seq.)
11. Defines non-emergency transportation services, for purposes of the Medi-Cal Program, to include, at a minimum, round trip transportation for a beneficiary to obtain covered Medi-Cal services by passenger car, taxicab, or any other form of public or private conveyance, and mileage reimbursement when conveyance is in a private vehicle arranged by the beneficiary and not through a transportation broker, bus passes, taxi vouchers, or train tickets. (WIC 14132)
12. Establishes the Charge Ahead California Initiative which, among other things, includes the goal of placing at least one million ZEVs and NZEVs into service by January 1, 2023, and increasing access to these vehicles for disadvantaged, low-and- moderate-income communities and consumers. (HSC 44258 et seq.)
13. Establishes the Air Quality Improvement Program (AQIP), administered by ARB in consultation with local air districts, to fund programs that reduce criteria air pollutants, improve air quality, and provide research for alternative fuels and vehicles, vessels, and equipment technologies. (HSC 44274.5 et seq.)
14. Establishes the Clean Truck, Bus, Off-Road Vehicle and Equipment Technology Program, administered by ARB in conjunction with the California Energy Commission, to use Greenhouse Gas Reduction Funds for development, demonstration, pre-commercial pilot, and early commercial deployment of zero- and near zero-emission truck, bus, and off-road vehicle and equipment technologies. (HSC 39719.2)

This Bill:

1. States that “near-zero-emission vehicle” and “zero-emission vehicle” have the same meanings as those terms are defined in current law within the Charge Ahead California Initiative, a specified.
2. Requires CDA to administer a grant program to fund transportation to and from nonemergency medical services for older individuals and persons with disabilities, as specified, in coordination with the ARB and the DHCS, for the purpose of reducing greenhouse gas emissions.
3. Provides that eligible applicants who may apply for grants to include, but not be limited to, all of the following:
4. Local or regional transportation agencies that provide transportation services to seniors and persons with disabilities,
5. AAAs,
6. Counties, and
7. Public transit operators
8. Requires an applicant that has been awarded a grant to use the funds to provide transportation services as follows:
9. Eligible transportation includes transportation to and from nonemergency medical services for older individuals and persons with disabilities, as specified.
10. Eligible transportation shall be made available using the purchase, lease, operation, or maintenance of zero-emission or near-zero-emission vehicles with a capacity for 7, 12, or 15 passengers.
11. Permits CDA to use moneys allocated to the grant program to cover reasonable administrative costs incurred by the department.
12. Permits an applicant that has been awarded a grant to use grant moneys to cover reasonable administrative costs incurred by the applicant.
13. Permits moneys from the Greenhouse Gas Reduction Fund to be allocated, upon appropriation by the Legislature, to fund the grant program.

FISCAL IMPACT

According to the Assembly Appropriations Committee Analysis on May 6, 2019, this bill would likely generated the following fiscal impact:

1. Unknown, likely significant cost pressures to fund the grant program. Costs will depend upon how the program is designed. For example, if grants were provided at a level between $10,000 and $50,000 per county, assuming half of all counties were funded, costs pressures would be from $260,000 to $1.3 million per funding cycle.
2. Ongoing annual CDA costs of approximately $225,000 to establish and administer the grant program.
3. Ongoing annual ARB costs of approximately $180,000 for tracking, reporting and developing quantification methods over the course of the program.
4. Unknown DHCS costs to consult with CDA on the administration of the grant program.

BACKGROUND AND DISCUSSION

Purpose of the Bill:

According to the author, “California has many seniors and people with disabilities who suffer from chronic, serious illnesses that limit their mobility in communities throughout the state. Resources for non-emergency medical transportation are limited in many communities and, where they are available, the vehicles used in those communities use fuels that contribute to air pollution. Significantly, these disadvantages that contribute to a lack of access the health care result in higher morbidity and mortality rates. Addressing geographic distance and transportation difficulties for elderly and disabled patients is a cost-effective way of improving the quality of life and health outcomes for vulnerable populations, while utilizing zero-emission or near-zero emission vehicles to reduce transportation barriers provides the important co-benefit of improving local air quality and reducing emissions.”

Department of Aging and Area Agencies on Aging

CDA administers programs that serve older adults, adults with disabilities, family caregivers, and residents in long-term care facilities throughout the state. CDA administers funds allocated under the federal OAA, the Older Californians Act, and through the Medi-Cal Program. CDA works with the state’s 33 AAAs to assist them in leveraging federal OAA Title IIIB Supportive Services Program resources that can be used to provide a variety of transportation services. AAAs can use these funds for assisted transportation (typically provided door-to-door from home to service) and general transportation services (typically through vouchers, transit passes, volunteer transportation assistance, and transportation to congregate meal sites). In fiscal year 2018-19, 79 percent of the AAAs fund general transportation services and 30 percent fund assisted transportation services.

Air Resources Board

The ARB has invested in similar grant programs including the Car-Sharing and Mobility Options Pilot Program which provides funding for government entities or non-profit organizations to start or expand car share and mobility programs for residents in disadvantaged communities. Additionally, the ARB has created the Hybrid and Zero-Emission Truck and Bus Voucher Incentive Project and the Low NOx Engine Incentive Program. For commercial vehicles, ARB provides grants up to $300,000 for the purchase or lease of a zero-emission truck or bus and up to $9,000 for eligible hybrid trucks and buses. A variety of buses are eligible for vouchers, including school, transit, commercial and shuttle buses. In addition, the Clean Vehicle Rebate Program provides up to $7,000 to California residents who purchase or leases a new near-zero or zero-emission vehicle. Public fleets are eligible to receive up to 30 rebates per calendar year.

Traveling Towards Disease: Transportation Barriers to Health Care Access

In Traveling Towards Disease: Transportation Barriers to Health Care Access. Syed, Gerber and Sharp. October 2013), the authors examined 61 peer-reviewed studies on transportation barriers to healthcare access. Overall, the studies found that transportation barriers are an important barrier to healthcare access, particularly to persons with lower incomes or are under insured or uninsured. Transportation barriers can lead to rescheduled or missed health appointments, delayed care, and missed or delayed medication use. These consequences may lead to poor health management of chronic illness and thus poorer health outcomes. Ultimately, transportation barriers may mean the difference between worse clinical outcomes that could trigger more emergency room visits and timely care that can lead to improved outcomes.

Related/Prior Legislation:

AB 2877 (Mathis, 2018) would have required ARB to provide grants to rural counties for the purchase, operation and maintenance of NZEVs and ZEVs and required these counties to provide seniors and the disabled with non-emergency transportation services using these vehicles. This bill did not pass out of Assembly Appropriations Committee.

AB 398 (E. Garcia, Chapter 135, Statutes of 2017) among other things, extended cap-and-trade provisions until December 31, 2030.

AB 2394 (E. Garcia, Chapter 615, Statutes of 2016) required the Medi-Cal program to cover nonemergency medical transportation for a beneficiary to obtain covered Medi-Cal services.

SB 32 (Pavley, Chapter 249, Statutes of 2016) required ARB to ensure that statewide GHG emissions are reduced at least 40 percent below 1990 levels by 2030.

SB 1275 (de León, Chapter 530, Statutes of 2014) established the Charge Ahead Initiative, to provide incentives to increase the availability of ZEVs and NZEVs, particularly to low-income and moderate-income consumers and disadvantaged communities.

AB 32 (Núñez, Chapter 488, Statutes of 2006) required ARB to develop a plan of how to reduce emissions to 1990 levels by the year 2020, authorized cap-and-trade and also required ARB to ensure that, to the extent feasible, GHGs reduction requirement and programs direct public and private investment toward the most disadvantaged communities.

COMMENTS

The amount of grant funding provided under this proposal would be determined by the Legislature through the annual state budget process.

The bill provides no direction to the CDA on grant program design, other than directing the department to work in coordination with the ARB and DHCS. The author might consider including more specificity with how the grant should be administered.

This bill has been doubled-referred, should it pass out of this committee, it will be referred to the Senate Committee on Environmental Quality.

PRIOR VOTES

POSITIONS

Support:

None received

Oppose:

None received

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 970

Author:(Salas)

As Amended Ver:April 12, 2019

Majority vote

SUMMARY:

Requires the California Department of Aging (CDA), in coordination with the Air Resources Board (ARB) and the Department of Healthcare Services (DHCS), to administer a grant program for the purchase, lease, operation or maintenance of zero-emission vehicles (ZEVs) and near-zero-emission vehicles (NZEVs) to provide seniors and the disabled with non-emergency transportation services.

Major Provisions

1. Requires grant recipients to provide seniors and the disabled with non-emergency transportation services using these vehicles in order to reduce greenhouse gas (GHG) emissions.
2. Authorizes, but does not limit, eligibility to the following entities:
   1. Local or regional transportation agencies that provide transportation services to seniors and person with disabilities.
   2. Area Agencies on Aging (AAA).
   3. Counties.
   4. Public transit operators.
3. Requires grant recipients to provide transportation services using the purchase, lease, operation or maintenance of ZEVs or NZEVs with a capacity for seven, 12 or 15 passengers.
4. Authorizes moneys from the Greenhouse Gas Reduction Fund (GGRF) to be used to fund the grant program, upon appropriation by the Legislature.

COMMENTS:

According to a study entitled Traveling Towards Disease: Transportation Barriers to Health Care Access, it was noted that "Millions of Americans face transportation barriers. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes."

Studies conducted by the American Hospital Associations have shown that transportation barriers are the third leading cause of missing a medical appointment for seniors across the country. Another study by Health Outreach Partners identified transportation as the second most prevalent barrier to accessing health care serves among underserved populations. In addition to transportation barriers, the same study also showed that living in a rural area was a top barrier to health care access.

CDA administers programs that serve older adults, adults with disabilities, family caregivers and residents in long-term care facilities throughout the state. CDA administers funds allocated under the federal Older Americans Act and the Older Californians Act and through the Medi-Cal program.

DHCS administers Medi-Cal transportation programs. Medi-Cal offers transportation to and from appointments for services covered by Medi-Cal. This includes transportation to medical, dental, mental health or substance abuse appointments, and to pick up prescriptions and medical supplies. 

ARB has a statutory role to coordinate with an administering agency to develop guidelines, including tracking and reporting requirements, for GGRF-funded programs.

According to the Author:

Resources for non-emergency medical transportation are limited in many communities, and, where they are available, the vehicles used in those communities use fuels that contribute to air pollution… Addressing geographic distance and transportation difficulties for elderly and disabled patients is a cost-effective way of improving the quality of life and health outcomes for vulnerable populations, while utilizing ZEVs or NZEVs to reduce transportation barriers provides the important co-benefit of improving local air quality and reducing emissions.

Arguments in Support:

Arguments in Opposition:

FISCAL COMMENTS:

According to the Assembly Appropriations Committee:

1. Unknown, likely significant cost pressures to fund the grant program (GGRF). Costs will depend upon how the program is designed. For example, if grants were provided at a level between $10,000 and $50,000 per county, assuming half of all counties were funded, costs pressures would be from $260,000 to $1.3 million per funding cycle.
2. Ongoing annual CDA costs of approximately $225,000 to establish and administer the grant program (GGRF).
3. Ongoing annual ARB costs of cost of approximately $180,000 for tracking, reporting and developing quantification methods over the course of the Program (GGRF).
4. Unknown DHCS costs to consult with CDA on the administration of the grant program (GGRF).

VOTES:

ASM AGING AND LONG-TERM CARE: 7-0-0

YES: Nazarian, Voepel, Boerner Horvath, Kalra, Lackey, Reyes, Blanca Rubio

ASM TRANSPORTATION: 14-1-0

YES: Frazier, Fong, Aguiar-Curry, Berman, Bigelow, Chu, Cunningham, Daly, Diep, Gipson, Grayson, Medina, Nazarian, O'Donnell

NO: Friedman

ASM APPROPRIATIONS: 18-0-0

YES: Gonzalez, Bigelow, Bloom, Bonta, Brough, Calderon, Carrillo, Chau, Diep, Eggman, Fong, Gabriel, Eduardo Garcia, Maienschein, Obernolte, Petrie-Norris, Quirk, Robert Rivas

UPDATED:

VERSION: April 12, 2019

CONSULTANT: Barry Brewer / AGING & L.T.C. / (916) 319-3990 FN: 0000682

Date of Hearing: May 8, 2019

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 970

Author:(Salas) – As Amended Ver:April 12, 2019

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires the California Department of Aging (CDA), in coordination with the Air Resources Board (ARB) and the Department of Healthcare Services (DHCS), to administer a grant program for the purchase, lease, operation or maintenance of zero-emission vehicles (ZEVs) and near-zero-emission vehicles (NZEVs) to provide seniors and the disabled with non-emergency transportation services. Specifically, this bill:

1. Requires grant recipients to provide seniors and the disabled with non-emergency transportation services using these vehicles in order to reduce greenhouse gas (GHG) emissions.
2. Authorizes, but does not limit, eligibility to the following entities:
3. Local or regional transportation agencies that provide transportation services to seniors and person with disabilities.
4. Area Agencies on Aging (AAA).
5. Counties.
6. Public transit operators.
7. Requires grant recipients to provide transportation services using the purchase, lease, operation or maintenance of ZEVs or NZEVs with a capacity for seven, 12 or 15 passengers.
8. Authorizes moneys from the Greenhouse Gas Reduction Fund (GGRF) to be used to fund the grant program, upon appropriation by the Legislature.

FISCAL EFFECT:

1. Unknown, likely significant cost pressures to fund the grant program (GGRF).

Costs will depend upon how the program is designed. For example, if grants were provided at a level between $10,000 and $50,000 per county, assuming half of all counties were funded, costs pressures would be from $260,000 to $1.3 million per funding cycle.

1. Ongoing annual CDA costs of approximately $225,000 to establish and administer the grant program (GGRF).
2. Ongoing annual ARB costs of cost of approximately $180,000 for tracking, reporting and developing quantification methods over the course of the Program (GGRF).
3. Unknown DHCS costs to consult with CDA on the administration of the grant program (GGRF).

COMMENTS:

1. Purpose. According to the author:

Resources for non-emergency medical transportation are limited in many communities, and, where they are available, the vehicles used in those communities use fuels that contribute to air pollution...Addressing geographic distance and transportation difficulties for elderly and disabled patients is a cost-effective way of improving the quality of life and health outcomes for vulnerable populations, while utilizing ZEVs or NZEVs to reduce transportation barriers provides the important co-benefit of improving local air quality and reducing emissions.

1. Background. CDA administers programs that serve older adults, adults with disabilities, family caregivers and residents in long-term care facilities throughout the state. CDA administers funds allocated under the federal Older Americans Act and the Older Californians Act and through the Medi-Cal program.

DHCS administers Medi-Cal transportation programs. Medi-Cal offers transportation to and from appointments for services covered by Medi-Cal. This includes transportation to medical, dental, mental health or substance abuse appointments, and to pick up prescriptions and medical supplies.

There are two types of transportation for appointments. Nonemergency medical transportation is transportation by ambulance, wheelchair van or litter van for those who cannot use public or private transportation. Nonmedical transportation is transportation by private or public vehicle for people who do not have another way to get to their appointment.

ARB has a statutory role to coordinate with an administering agency to develop guidelines, including tracking and reporting requirements, for GGRF-funded programs.

This bill creates a new program at CDA, a department that has never administered GGRF programs.

This bill brings expertise with seniors, the disabled (CDA), existing Medi-Cal transportation programs (DHCS) and the keeper of the GGRF (ARB) together to create this program.

Analysis Prepared by: Jennifer Galehouse / APPR. / (916) 319-2081

Date of Hearing: April 22, 2019

ASSEMBLY COMMITTEE ON TRANSPORTATION

Jim Frazier, Chair

ABPCA Bill Id:AB 970 (

Author:Salas) – As Amended Ver:April 12, 2019

SUBJECT: California Department of Aging: grants: transportation

SUMMARY: Requires the California Department of Aging (CDA), in coordination with the Air Resources Board (ARB) and the Department of Healthcare Services (DHCS), to administer a grant program for the purchase, lease, operation or maintenance of zero-emission vehicles (ZEVs) and near-zero-emission vehicles (NZEVs); and requires grant recipients to provide seniors and the disabled with non-emergency transportation services using these vehicles. Specifically, this bill:

1. Requires CDA, in coordination with ARB and DHCS, to administer a grant program for the purchase, lease, operation or maintenance of ZEVs and NZEVs.
2. Requires grant recipients to provide seniors and the disabled with non-emergency transportation services using these vehicles in order to reduce greenhouse gas (GHG) emissions.
3. Authorizes, but does not limit, the following entities to apply for grants:
4. Local or regional transportation agencies that provide transportation services to seniors and person with disabilities;
5. Area Agencies on Aging (AAA);
6. counties; and
7. public transit operators.
8. Requires grant recipients to provide transportation services using the purchase, lease, operation, or maintenance of ZEVs or NZEVs with a capacity for 7, 12, or 15 passengers.
9. Allows applicants to use grant monies to cover reasonable administrative costs.
10. Provides funding for the grant program from the Greenhouse Gas Reduction Fund (GGRF) upon appropriation by the Legislature
11. Allows CDA to use GGRF funds to cover reasonable costs incurred to administer the grant program.
12. Defines a "near-zero-emission vehicle" as a vehicle that utilizes zero-emission technologies, enables technologies that provide a pathway to zero-emissions operations, or incorporates other technologies that significantly reduce criteria pollutants, toxic air contaminants, and GHG emissions, as defined by ARB in consultation with the State Energy Resources Conservation and Development Commission, consistent with meeting the state's mid-and long-term air quality standards and climate goals.
13. Defines a "zero-emission vehicle" as a vehicle that produces no emissions of criteria pollutants, toxic air contaminants, and GHG when stationary or operating, as determined by ARB.

EXISTING LAW:

1. Requires ARB, pursuant to California Global Warming Solutions Act of 2006 [AB 32 (Núñez), Chapter 488, Statutes of 2006], to adopt a GHG emissions limit equivalent to 1990 levels by 2020 and to use market-based mechanisms (cap-and-trade) to achieve compliance with these regulations.
2. Requires, pursuant to SB 32 (Pavley), Chapter 249, Statutes of 2016, that ARB ensure that statewide GHG emissions are reduced to at least 40% below 1990 levels by 2030.
3. Establishes the GGRF in the State Treasury, requires all moneys, except for fines and penalties, collected pursuant to cap and trade be deposited in the fund and requires the Department of Finance, in consultation with ARB and any other relevant state agency, to develop, as specified, an investment plan for the moneys deposited in the GGRF, and makes the GGRF funds available for appropriation by the Legislature.
4. Requires CDA to designate various private nonprofit or public agencies as AAAs to work for the interests of older Californians within a planning and service area and provide a broad array of social and nutritional services.
5. States that the mission of CDA is to provide leadership to the AAAs in developing systems of home-and community-based services that maintain individuals in their own homes or the least restrictive homelike environments.
6. Establishes the Medi-Cal program, administered by DHCS, under which qualified low-income persons receive health care benefits and, in part, governed and funded by federal Medicaid program provisions.
7. Defines non-emergency transportation services, for purposes of the Medi-Cal Progam, to include, at a minimum, round trip transportation for a beneficiary to obtain covered Medi-Cal services by passenger car, taxicab, or any other form of public or private conveyance, and mileage reimbursement when conveyance is in a private vehicle arranged by the beneficiary and not through a transportation broker, bus passes, taxi vouchers, or train tickets.
8. Establishes the Charge Ahead California Initiative pursuant to SB 1275 (de León), Chapter 530, Statutes of 2014, that, among other things, includes the goal of placing at least one million ZEVs and NZEVs into service by January 1, 2023, and increasing access to these vehicles for disadvantaged, low-and- moderate-income communities and consumers.
9. Establishes the Air Quality Improvement Program (AQIP), administered by ARB in consultation with local air districts, to fund programs that reduce criteria air pollutants, improve air quality, and provide research for alternative fuels and vehicles, vessels, and equipment technologies.
10. Establishes the Clean Truck Program, administered by ARB in conjunction with the California Energy Commission, to use GGRF funds for development, demonstration, pre-commercial pilot, and early commercial deployment of zero- and near zero-emission truck, bus, and off-road vehicle and equipment technologies.

FISCAL EFFECT: Unknown

COMMENTS: California has established a number of policies, goals, and programs to improve air quality and reduce GHG emissions. Most notably, AB 32 established the goal of reducing GHG emissions to 1990 levels by the year 2020 and, more recently, SB 32 (Pavley), Chapter 248, Statutes of 2016, established the more aggressive goal of reducing emissions 40% below 1990 levels by 2030. Along with establishing emissions reduction goals, AB 32 allowed for the establishment, by regulation, of cap-and-trade with funds deposited into the GGRF used to fund emission reduction programs.

Using GGRF funds and under the direction of SB 1275, ARB has invested in light-duty pilot projects, including the Car Sharing and Mobility Options Pilot Project which provides funding for government entities or non-profit organizations to start or expand car share and mobility programs for residents of disadvantaged communities. Additionally under the guidance of the Clean Truck program and the creation of the AQIP, ARB created the Hybrid and Zero-Emission Truck and Bus Voucher Incentive Project (HVIP) and Low NOx Engine Incentives program. For commercial vehicles, ARB provides grants of up to $300,000 for the purchase or lease of a zero-emission truck or bus and up to $9,000 for eligible hybrid trucks and buses. A variety of buses are available for HVIP vouchers, including school buses, transit buses, commercial buses, and shuttle buses. In addition, the Clean Vehicle Rebate Program (CVRP), created under AQIP, provides up to $7,000 to California residents who purchase or lease a new NZEV or ZEV. Private and public entities can access rebates through the CVRP. In fact, public fleets are eligible to receive up to 30 rebates per calendar year.

This bill creates a similar program, under CDA, in order to expand mobility options exclusively for elderly and disabled individuals to attend their doctors’ appointments. CDA administers programs that serve older adults, adults with disabilities, family caregivers, and residents in long-term care facilities throughout the state. CDA administers funds allocated under the federal Older Americans Act (OAA), the Older Californians Act, and through the Medi-Cal program. CDA does not currently operate transportation-related programs explicitly analogous to those specified in this bill. However, it does work with the state’s 33 AAAs to assist them in leveraging federal OAA Title IIIB Supportive Services Program resources that can be used by the AAAs to provide a variety of transportation services for eligible older adults. There are two types of transportation categories that the AAAs can fund (assisted transportation and general transportation services). These are determined through a local needs assessment process. In Fiscal Year 2018-19, 79% of the AAAs fund general transportation services and 30% of the AAAs fund assisted transportation services. Under the general transportation category, AAAs may fund various types of services/activities, such as travel vouchers, transit passes and volunteer transportation services, and transportation to congregate meal sites. Under the assisted transportation category, AAAs may fund assistance and transportation, for example an escort to assist a person who has difficulties (physical or cognitive impairment).

Additionally, the federal government authorizes the Medi-Cal program (which may provide service for the elderly and disabled) to specifically cover non-emergency medical transportation services. To clarify and align the state with this authorization, in 2016, the Legislature passed AB 2394 (E. Garcia) which required Medi-Cal to cover non-medical transportation for a beneficiary to obtain covered Medi-Cal services. Non-emergency medical transportation is provided when necessary to obtain program covered medical services and when the beneficiary's medical and physical condition is such that transport by ordinary means of private or public conveyance is medically contraindicated. This type of medical transportation is subject to prior authorization. Each authorization request for such transportation must be accompanied by either a prescription or order signed by a physician, dentist, or podiatrist, which describes the medical reasons necessitating the use of non-emergency medical transportation. Authorization is granted only for the lowest cost type of medical transport that is adequate for the patient's medical needs and is available to transport the patient at the time transportation is required.

Under the Americans with Disabilities Act, transit operators are required to provide transportation services to the elderly and disabled (paratransit services). However, lack of transit funding or limited service/routes can be a real barrier for the elderly and disabled to access healthcare services. Transit operators, locals and counties can work with private entities and/or non-profits to provide paratransit services. These services can be funded or aided from, as mentioned, federal, local or state funding.

Although Medi-Cal and many transit operators are required to provide transportation services to the disabled and the elderly, there is still a huge need for the disabled and elderly population to attend their medical appointments because of the requirements, restrictions or lack of funding current services may have, and the mobility challenges associated with these residents.

According to the author, “Resources for non-emergency medical transportation are limited in many communities, and, where they are available, the vehicles used in those communities use fuels that contribute to air pollution...Addressing geographic distance and transportation difficulties for elderly and disabled patients is a cost-effective way of improving the quality of life and health outcomes for vulnerable populations, while utilizing ZEVs or NZEVs to reduce transportation barriers provides the important co-benefit of improving local air quality and reducing emissions.”

Writing in support, the Contra Costa Board of Supervisors states, “This bill would provide grant funding for transportation programs to/from nonemergency medical services for older individuals and persons with a disability...The bill is timely, improvements to this type of transportation are critical if we are to improve emergency response to this vulnerable population.” They also urge that the author consider amendments that consider existing coordinated efforts and plans, and the ability to leverage funding for those efforts as well.

In opposition, the Sierra Club notes “AB 970 would provide clean transportation assistance for seniors and those living with disabilities, which we agree is very important. However, the legislation currently states that the CDA would receive GGRF appropriations for ZEVs and NZEVs. Only ZEVs should be eligible for the GGRF appropriations. We would remove our opposition if the reference to NZEVs was omitted.”

Committee Comments: While it is a laudable goal to provide more resources to transport our most vulnerable populations to their doctors’ appointments, the author may want to consider ways this bill can better coordinate existing transportation services and resources. It would be a disadvantage to the state and the targeted community to fund duplicative and uncoordinated efforts.

Previous Legislation: AB 2877 (Mathis) of 2018 would have required ARB to provide grants to rural counties for the purchase, operation and maintenance of NZEVs and ZEVs and required these counties to provide seniors and the disabled with non-emergency transportation services using these vehicles.

AB 398 (E. Garcia), Chapter 135, Statutes of 2017, among other things, extended cap-and-trade provisions until December 31, 2030.

AB 2394 (E. Garcia), Chapter 615, Statutes of 2016, required the Medi-Cal program to cover non-emergency medical transportation for a beneficiary to obtain covered Medi-Cal services.

SB 32 (Pavley), Chapter 249, Statutes of 2016, required ARB to ensure that statewide GHG emissions are reduced at least 40% below 1990 levels by 2030.

SB 1275 (de León), Chapter 530, Statutes of 2014, established the Charge Ahead Initiative, to provide incentives to increase the availability of ZEVs and NZEVs, particularly to low-income and moderate-income consumers and disadvantaged communities.

AB 32 (Núñez), Chapter 488, Statutes of 2006, required ARB to develop a plan of how to reduce emissions to 1990 levels by the year 2020, authorized cap-and-trade and also required ARB to ensure that, to the extent feasible, GHGs reduction requirement and programs direct public and private investment toward the most disadvantaged communities.

REGISTERED SUPPORT / OPPOSITION:

Support

Contra Costa County Board of Supervisors

Imperial County Area Agency on Aging and Public Administration

Two Private Individuals

Opposition

Sierra Club

Analysis Prepared by: Cynthia Alvarez / TRANS. / (916) 319-2093

Date of Hearing: April 2, 2019

ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE

Adrin Nazarian, Chair

ABPCA Bill Id:AB 970 (

Author:Salas) – As Amended Ver:March 20, 2019

SUBJECT: California Department of Aging: grants: transportation.

SUMMARY: An act relating to aging. Specifically, this bill:

1. Requires the Department of Aging to administer a grant program and receive applications from area agencies on aging to fund transportation to and from nonemergency medical services for older individuals with disabilities and persons with a disability who reside in rural, desert, or mountain areas within a planning and service area, for the purpose of reducing greenhouse gas emissions.
2. Requires that transportation be made available using the purchase, lease, or maintenance of zero-emission or near-zero-emission vehicles with a capacity for 7, 12, or 15 passengers.
3. Authorizes the allocation of moneys from the Greenhouse Gas Reduction Fund and the Air Quality Improvement Fund, upon appropriation by the Legislature, to fund the grant program.

EXISTING LAW:

1. The California Global Warming Solutions Act of 2006, designates the State Air Resources Board as the state agency charged with monitoring and regulating sources of emissions of greenhouse gases. The act authorizes the state board to include the use of market-based compliance mechanisms.
2. Requires all moneys, except for fines and penalties, collected by the state board as part of a market-based compliance mechanism to be deposited in the Greenhouse Gas Reduction Fund and to be available for appropriation.
3. Establishes the Air Quality Improvement Program, which is administered by the state board for the purpose of funding projects related to, among other things, the reduction of criteria air pollutants and improvement of air quality.
4. Requires that moneys in the Air Quality Improvement Fund, upon appropriation by the Legislature, be expended by the state board in accordance with the program.
5. Requires the California Department of Aging to designate various private nonprofit or public agencies as area agencies on aging to work for the interests of older Californians within a planning and service area and provide a broad array of social and nutritional services.
6. States that the mission of the Department of Aging is to provide leadership to the area agencies on aging in developing systems of home-and community-based services that maintain individuals in their own homes or the least restrictive homelike environments.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

Author’s Statement: According to the author, “Providing clean transportation assistance to health care for seniors and those living with disabilities in areas that already have enormous barriers to health care access and, in many cases, live in communities that suffer from poor air quality, would help increase access to care for vulnerable populations while also improving local air quality and reducing overall emissions, thus providing significant health benefits to the populations that live in disadvantaged areas and throughout the state.”

BACKGROUND:

California has many seniors and people with disabilities who suffer from chronic, serious illnesses that limit their mobility and who live in rural, mountain or desert communities throughout the state. Resources for non-emergency medical transportation are limited in those communities, and, where they are available, the vehicles used in those communities use fuels that contribute to air pollution.

Significantly, these disadvantages that contribute to a lack of access to health care result in higher morbidity and mortality rates compared to those of their urban counterparts. Addressing geographic distance and transportation difficulties for elderly and disabled patients is a cost-effective way of improving the quality of life and health outcomes for vulnerable populations, while utilizing zero-emission or near-zero emission vehicles to reduce transportation barriers provides the important co-benefit of improving local air quality and reducing emissions.

Rural populations experience many difficulties in accessing health care services, with one of the key barriers being transportation. In rural areas, residents need to travel greater distances to access different parts of the health care system, which in addition to having less access to public transportation, is a substantial barrier to health care.

At the same time, elderly individuals and individuals with disabilities have greater health care needs than other rural residents, and living in rural areas causes them additional difficulties. The Rural Health Information Hub states that rural populations most likely to need transportation services to maintain their health and well-being include seniors and people with disabilities.

According to a study entitled Traveling Towards Disease: Transportation Barriers to Health Care Access, it was noted that “Millions of Americans face transportation barriers. Transportation barriers lead to rescheduled or missed appointments, delayed care, and missed or delayed medication use. These consequences may lead to poorer management of chronic illness and thus poorer health outcomes.”

It also noted that among the elderly reporting any barrier to health care access, 21 percent reported having transportation barriers. Studies conducted by the American Hospital Associations have shown that transportation barriers are the third leading cause of missing a medical appointment for seniors across the country. Another study by Health Outreach Partners identified transportation as the second most prevalent barrier to accessing health care serves among underserved populations. In addition to transportation barriers, the same study also showed that living in a rural area was a top barrier to health care access.

ISSUES TO CONSIDER:

Are Greenhouse Gas Reduction Funds and the Air Quality Improvement Funds the appropriate use of funds for this grant program? For example, the Air Resources Board has numerous programs to provide funding and incentives for the purchase of National Zero Emissions Vehicles (NZEV) and Zero-Emission Vehicles (ZEV). Another example is, the Clean Vehicle Rebate Program (CVRP) that provides up to $7,000 to California residents who purchase or lease a new NZEV or ZEV. Public agencies can get up to 30 rebates annually. Also, are low carbon transportation dollars more appropriate funding source? Additionally, Area Agencies on Aging are not typically the primary providers of transportation in an area and would have to develop the capacity to run a transportation program.

Because this bill is double refereed to the Transportation Committee which will hear the bill next, is it the more appropriate committee to work those issues out?

REGISTERED SUPPORT / OPPOSITION:

Support

Imperial County Area Agency on Aging Public Administrator

Two individuals.

Opposition

None on file.

Analysis Prepared by: Barry Brewer / AGING & L.T.C. / (916) 319-3990